A Case of Intraosseous Microcystic Meningioma Without a Mass Lesion

Both intraosseous and microcystic meningiomas are rare tumor types. We report the case of a 66-year-old woman with intraosseous microcystic meningioma without a mass lesion. She presented with a rare intraosseous microcystic meningioma manifesting as pain. Radiological examination revealed an osteolytic lesion in the right parietal bone. Magnetic resonance (MR) images showed iso- to hypointensity on T₁-weighted images and hyperintensity on T₂-weighted images corresponding to the lesion. T₁-weighted MR imaging with gadolinium enhancement better defined the marginal area. The inner table of the skull was disrupted prominently, and both sides of the outer table were eroded. There was fluid leakage during surgery but no obvious tumor mass. Histological examination revealed microcystic meningioma in the inner part of the defective bone. A macroscopic lesion was not found, because most of the tumor comprised microcysts, and their contents leaked out during the surgical procedure. Intraosseous microcystic meningioma may be considered as one of the differential diagnoses when the intraosseous tumor in the skull has fluid leakage and does not have a mass lesion during the surgery.     

Peritumoral cystic meningioma

A case of 39 years old male is described who presented with headache, right-sided focal fits and decreased power in the right hand. CT scan brain showed a left fronto-parietal cystic lesion with centrolateral intramural nodule with homogenous enhancement. At surgery, the extra-axial lesion with cyst containing xanthochromic fluid had a well-defined capsule that could easily be separated from the peri-lesional cortical surface. The dural-based nodule with its cyst wall was resected in toto. The histopathology of mural nodule was reported as meningioma while the cyst wall histology revealed meningothelial cells.     

Intraosseous calvarial meningioma of the skull presenting as a solitary osteolytic skull lesion: Case report and review of the literature

Summary Intraosseous calvarial meningiomas, defined as meningiomas confined to the skull with no epidural or subcutaneous component, are rare and usually exhibit osteoblastic activity. We present a case of a primary intraosseous meningioma in the right frontal bone that presented radiologically as a solitary lytic skull lesion and was completely excised. The lesion was benign without recurrence for 11/2 years. According to our review of the literature, our case is the first with documentation on computed tomography. In cases of solitary osteolytic skull lesions, meningioma should be considered even though it may not seem likely, because management will be directed to radical excision with good prognosis rather than biopsy.     

Orthokeratinized Odontogenic Cyst of the Mandible with Heterotopic Cartilage

Cartilaginous metaplasia is a rare but well-documented phenomenon occurring in the wall of odontogenic keratocyst. The mural cartilage not associated with odontogenic keratocyst has been reported only once in a maxillary teratoid cyst of congenital origin to our knowledge. A case presented is a 38-year-old man with intraosseous keratinizing epidermoid cyst in the mandible, the wall of which contained a nodule of mature hyaline cartilage. The present lesion likely represents a previously undescribed, histologic hybrid consisting of orthokeratinized odontogenic cyst and cartilaginous heterotopia.     

Cystic falx meningioma: report of a case with difficulty in radiologic diagnosis]

A case of cystic falx meningioma in the frontal region in which preoperative neuroradiologic diagnosis was difficult is reported. This 33-year-old man had suffered from epileptic seizures three times in one month. Physical and neurological examinations on admission were normal. A cystic mass with a small nodule was found on CT in the frontal region. Thin wall was enhanced smoothly and the nodule attached to the falx was enhanced heterogeneously. The mass was considered to be an extra-axial lesion on MRI. The right anterior falcine artery seemed to feed the mass. Bifrontal craniotomy was performed. Cyst was evacuated, and a soft reddish mass was subtotally removed. Cyst fluid was yellowish and protein content was 3.5 g/dl. Histopathological diagnosis was a meningotheliomatous meningioma and tumor cells were present also in the thin cyst wall. At the second operation the mass was completely removed, cyst wall inclusive. When we encounter a cystic mass in the sites of predilection of meningiomas, we have to consider the possibility of a cystic meningioma. If the mass has meningeal vascularization, a correct diagnosis is not difficult. Taking the location of the mass into consideration, an accurate interpretation of CT and MRI findings indicating extra-axial nature of the mass is indispensable.     

Recurrent cystic meningioma

The authors report a case of recurrent meningothelial meningioma with a large cyst. At the first operation, the mural nodule was totally resected and the cyst wall was removed as much as possible. This cystic tumor recurred six years later at the site where the first operation was performed. Histologically, the cyst wall contained islands of the same neoplastic cells as were previously found in the mural nodule. The authors discuss the preoperative diagnosis and mechanism of cyst formation, and emphasize the importance of complete removal of the cyst wall for permanent cure.     

Extracranial meningioma in the scalp skin 25 years after epidural hematoma surgery: A case report

Introduction and importanceExtracranial meningiomas are rare, accounting for 1–2% of all meningiomas with just published in the form of a case report or series. They are categorized as primary or secondary tumors. In this paper, we present a case of extracranial meningioma in the scalp skin, which is believed in Vietnam's first case.Case presentationA 38 years old male with a history of brain epidural hematoma surgery in 1995 presented a subcutaneous protruding mass, which revealed approximately 3-centimeters from an incision scar in the left frontoparietal scalp. The tumor was firm, mobilized with contrast enhancement on magnetic resonance image. The complete surgical excision of the whole mass was performed, and histological examination revealed a WHO grade I meningioma.Clinical discussionEpidemiology, classification, diagnosis, treatment as well as prognosis of extracranial meningioma were discussed. We also hypothesized the emergence of extracranial meningioma after an epidural hematoma surgery.ConclusionExtracranial meningioma is quite rare, but it could be presented after a traumatic brain injury. Neurosurgery was the first choice, safe and effective treatment.     

Cystic meningioma. Case report and literature review

BACKGROUND: Cystic meningioma is a rare variety of meningioma. It represents 1,6 to 10% of intracranial meningiomas, the authors report a case of intracranial cystic meningioma with a review of literature. CASE REPORT: A 46-year-old female presented with left parietooccipital headache followed by right side hemiparesis. CT scan brain showed a left parietal tumor with double solid and cystic components thought to be glioma or metastasis preoperatively. At surgery the extraaxial solid and cystic lesion had a well defined capsule that could be easily separated from the perilesional cortical surface. The tumor was totally removed. The histological study showed a cystic meningioma. CONCLUSION: Cystic meningioma is an uncommon tumor that should be considered in the differential diagnosis of brain tumors with a cystic component.     

Intraoperative management of cystic meningiomas

Cystic meningiomas are uncommon tumors that are easily confused with metastatic or glial tumors with cystic components. We report on our experience of intraoperative findings and management of peritumoral cyst wall and cyst fluid in cystic meningiomas. We reviewed all the meningiomas operated on at our department in a 3 1/2-year period (January 1998 to June 2001). Pathological and intraoperative findings of cystic meningiomas compared to noncystic meningiomas are examined. There were 111 cases of intracranial meningiomas operated on, including seven cystic meningiomas (6.3%). In six cases, we found peritumoral cyst configurations. The tumor locations of cystic meningiomas were the cerebral convexity and sphenoid ridge. One peritumoral cyst formation had meningioma cells in the cyst wall. Cytologic examination of the cystic fluid displayed the presence of meningiothelial cells in one case. In one case, intraoperative findings and pathological examination provided the diagnosis of two differently located meningiomas in one cyst configuration, its walls lined by clear arachnoid. Four of the seven cases had peritumoral cystic meningiomas of the atypical type according to the WHO classification. One case with intratumoral cyst configuration was associated with the anaplastic type (WHO °3). Intraoperative biopsies and histopathological studies of the cyst wall are recommended in peritumoral cystic meningiomas. Our observations suggest that cystic meningiomas have the potential to spread through cystic fluid to the cystic wall in peritumoral cyst configuration. The follow-up intervals should be short in cystic meningiomas. Electronic Publication     

Spinal cystic meningioma presenting as a ring enhancing lesion on MRI

Spinal meningiomas are much more common in women. The peak age incidence of presentation occurs in the sixth decade. Cystic meningiomas are rare and seem to have a predilection for children. We report a case of cystic spinal meningioma in a young man presenting as a ring enhancing lesion on Magnetic Resonance Imaging (MRI). This case is unusual because of the atypical features of the tumour, the relatively young age and sex of the patient.     

囊腔类肺癌CT特征分析

目的分析囊腔类肺癌的CT特征。方法回顾性分析经病理证实的24例囊腔类肺癌的CT表现。所有患者均接受平扫,其中4例同期接受增强扫描。结果 24例均为单发病灶。4例病灶CT表现为单纯囊腔,8例表现为囊腔伴周围磨玻璃密度影,7例表现为囊腔伴周围实性密度影,5例囊腔周围同时伴有磨玻璃及实性密度影;囊腔形态呈圆形或类圆形9例,不规则形15例;22例囊壁不光整,2例囊腔壁光整。4例接受CT增强扫描者囊腔周围实性密度影可见中度强化。13例囊腔内可见壁结节,20例囊腔内可见粗细不均的分隔;出现分叶征18例,毛刺征12例,血管集束征9例,胸膜凹陷征10例。结论囊腔类肺癌CT表现具有一定特征性,对囊腔及其周围CT表现进行综合分析有助于进一步明确诊断。     

Cerebral cystic hemangioblastoma

A 26-year-old man having a large left frontal lobe cystic mass due to a 1.5 cm capillary hemangioblastoma acting as a mural nodule is presented. The cerebral topographical location of hemangioblastoma is rare and the reported cases are summarized and analyzed. The distinction between hemangioblastoma and angioblastic meningioma is emphasized by the occurrence of a cystic capillary hemangioblastoma in the cerebrum.     

Primary intraosseous meningioma of the calvaria: analysis of the literature and case report.

Meningiomas are the most common of the benign intracranial neoplasms. They are uncommon as primary or secondary extracranial entities. Of these, the primary intraosseous variant may represent the rarest form. We report the case of a rare primary intraosseous meningioma presenting as a localized, symptom-free supraorbital bony expansion in an 81-year-old female patient and tabulate the previously reported cases of primary intraosseous meningiomas of the craniomaxillofacial region for analysis.     

Multi-recurrent invasive ameloblastoma: A surgical challenge

IntroductionAmeloblastomas are rare head and neck tumors, and yet the most common odontogenic neoplasms. They account for 1% and 11% of all head and neck and odontogenic tumors respectively. Embryologically, they originate from remnants of odontogenic epithelium. Their aggressive, destructive nature, as well as their anticipated high rate of recurrence, even after en bloc resection, poses a surgical predicament.PresentationWe present a case of a 56 year-old Asian female with a multi-recurrent invasive ameloblastoma. Initially, the lesion was mandibular in location for which she underwent a mandiblectomy. Later on, she presented with a maxillary ameloblastoma with invasion of both the anterior wall of the maxillary sinus and the floor of the orbit. The patient was operated twice and histopathology confirmed a cystic type recurrent ameloblastoma. A year later, she came with recurrent maxillary ameloblastoma and a maxillectomy was done. However, histopathology revealed a follicular ameloblastoma. Three years later, she presented with a retro-orbital ameloblastoma with infiltration to the temporal muscles. The patient was operated and the histopathologic examination revealed a partially cystic lesion with no malignant transformation.ConclusionThis case discusses available treatment options and emphasizes on the importance of long-term patient follow-up due to the biological behavior of ameloblastoma.     

Ossification in an extra-intradural spinal meningioma—pathologic and surgical vistas

Background contextIntradural and intratumorous ossification in spinal meningiomas are rare compared to their cranial counterparts. Extradural extension of the spinal meningioma is not uncommon. To the best of our knowledge, the ossification in an extra-intradural spinal meningioma is not yet reported in the literature.PurposeThe authors report a rare case of an extra-intradural spinal meningioma with ossification and calcification. The review of literature including the surgical challenges and the histologic variations as well as histogenesis of the ossified spinal meningioma is discussed.Study designCase report and review of the literature.MethodsA 61-year-old woman presented with complaints of numbness and weakness for 3 years, and gait disturbances for 6 months. Magnetic resonance imaging revealed a mass compressing the spinal cord at the T4 level.ResultsComplete resection of the tumor was achieved with coagulation and partial resection of the dura. Histopathological examination demonstrated a psammomatous spinal meningioma with intratumorous and intradural mature lamellar bone formation, complete with marrow and hematopoietic cells. The patient is asymptomatic at 3-year postoperative follow-up.ConclusionsDespite adherence of the ossified mass to the dura, arachnoid, and spinal cord, complete atraumatic resection of the mass was possible with favorable surgical outcome. In addition to calcification as a likely forerunner of ossification in the psammomatous subtype of meningioma, metaplastic differentiation of neoplastic cells to osseous and hematopoietic component might play a crucial role.     

A case report of simple mucinous cyst of pancreas detected by rupture

IntroductionSimple mucinous cyst (SMC) of pancreas is a disease defined by the Baltimore Consensus in 2014. Pancreatic mucus-producing neoplasms are considered to be premalignant tumors, but SMC is not considered to have a risk of malignancy or recurrence.Presentation of caseThe case was a woman in her 50s with a chief complaint of abdominal pain. A blood exam showed an increase in the inflammatory response, and a slight increase of Amylase. CT showed a cystic lesion 80 mm in size at tail of the pancreas, and disproportionate fat stranding and ascites around it. We diagnosed peritonitis associated with the rupture of a cystic lesion accompanied by pancreatitis. Abdominal pain was improving, and we decided to proceed with the detailed examination. MRI showed a uniform hyper-intensity on T2WI, and a nodular-like hypo-intensity was observed inside, which was enhanced. During the follow-up, the lesion had gradually grown and re-ruptured. As we could not deny malignancy by image findings, distal pancreatectomy was performed. The intracystic fluid was browny and turbid, and Amylase, CEA and CA19-9 of the cystic fluid were elevated. We diagnosed it SMC by histopathological findings. Currently, she had no recurrence for 1 year.DiscussionSMC is a type of true cysts, so rupture was rare. However, if the cyst wall becomes weak due to complications such as acute pancreatitis. It is probable that our case had pancreatitis and the cyst wall was weakened.ConclusionSMC detected by rupture was very rare, so we report this case.     

Intraductal papillary adenoma: Usefulness of magnetic resonance cholangiopancreatography in the diagnosis of cystic branch-duct dilatation of the pancreas

A 70-year-old woman with gastric cancer was referred to our hospital for further evaluation of a cystic mass in the head of the pancreas. Endoscopic ultrasonography (EUS) showed a mural nodule in the cystic mass. Endoscopic retrograde cholangio pancreatography (ERCP) revealed a cystic lesion with a filling defect caused by obstruction with mucus. Magnetic resonance cholangiopancreatography (MRCP) allowed visualization of the entire configuration of the cystic lesion despite the presence of mucus. Pancreatic juice was positive for K-ras point mutation. Pancreatoduodenectomy was performed, with a diagnosis of intraductal papillary adenoma or adenocarcinoma with gastric cancer. Pancreatography of the resected specimen showed a cystic lesion in the uncinate process, consistent with the MRCP findings. Histological examination revealed an intraductal papillary adenoma. MRCP is very useful for demonstrating the total configuration of cystic lesions and is not impeded by impacted mucin. Nevertheless, because of its lower spatial resolution, this noninvasive modality is of limited value in detecting mural nodules. At present, therefore, surgical indications for cystic lesion of the pancreas should be determined by comprehensively analyzing: size and sequential changes in size of the cyst; presence of mural nodules, cytologic examination for presence of malignant cells, and/or K-ras point mutation in pure pancreatic juice.     

Tumor-to-tumor metastases: Latent renal cell carcinoma discovered after elective surgical resection of a convexity meningioma

BackgroundTumor-to-tumor metastases are extremely rarely reported lesions, which usually involve an indolent lesion hosting a more aggressive neoplasm. We present an unusual initial manifestation of a previously unknown clear cell renal cell carcinoma as a tumor-to-tumor metastasis in a typical meningothelial meningioma.Case reportA 73-year old patient with transient left slight monoparesis was addressed to our Neurosurgical Department after being evaluated by his general practitioner and passing a cerebral MRI which revealed a right frontotemporal mass attached to the meninge. At presentation, no deficits were identified; therefore an elective surgery was proposed. Histological analysis revealed a typical meningothelial meningioma containing a metastatic clear cell renal cell carcinoma. Additional thoraco-abdominal computer tomography identified a 6 cm diameter lesion within the right kidney with radiological features highly suggestive of a primary clear cell renal cell carcinoma.ConclusionOur case highlights the need for a specialized neuropathological approach to clinical and imagistic indolent meningiomas, as they may require important differential diagnosis that can highly impact the treatment and follow-up of brain tumor patients.     

Cervical spinal extradural meningioma: Case report

Extradural meningiomas account for approximately 7% of all spinal meningiomas and are most commonly located in the thoracic spine. Although rare, they should be included in the differential diagnosis of an extradural contrast-enhancing mass. Prognosis depends greatly on the extent of surgical resection. If considered safe, complete resection should be attempted to decrease the risk of recurrence. We report a case of spinal epidural meningioma diagnosed in an elderly woman complaining of right cervicobrachial pain of several years duration, associated with diffuse paresthesia and permanent numbness of her right index finger. The surgical removal of the tumor was incomplete because of the deep lateral extension of the lesion.     

Intraventricular ganglioglioma: a short illustrated review

The following review of the literature describes the ganglioglioma, an uncommon mixed glioneuronal neoplasm, most often of low-grade histology, with a small, albeit well-documented, malignant potential. These tumors exhibit a strong epileptogenic propensity and most often present as new onset seizures or are discovered after a long history of refractory epilepsy. Despite their indolent course, the importance of gross total resection is well recognized to prevent anaplastic and malignant degeneration. Morphologically, the neoplasm is often cystic with an enhancing mural nodule, but can also be entirely solid. They are most often found in the temporal lobe but have been found throughout the neuraxis. An exceedingly rare location of the ganglioglioma is within the lateral ventricle. A systematic literature search revealed only eight reports documenting the occurrence of a ganglioglioma within the lateral ventricle. We describe an illustrative case of an intraventricular ganglioglioma with a prominent cystic component and enhancing mural nodule, which represents the classic radiographic appearance of gangliogliomas described in other locations. A superior parietal lobule approach offered excellent surgical access for tumor removal and the patient has remained free of neurological deficits following surgery. Regardless of location within the central nervous system, ganglioglioma should be on the differential diagnosis for any cystic mass with a mural nodule, particularly in the setting of epilepsy.